Some good news! Access to certain medical supplies and medical equipment through the NIHB Program has been improved!

Oct 09, 2018

Withdrawal of prior authorization for certain items for mobility and personal care

The following items no longer require prior approval when they are provided within Program price and frequency guidelines:

• Bath chair

• Commode, standard

• Elevated raised toilet seat with arms

• Floor-to-ceiling pole

• Grab bar-bed purchase

• Safety frame for toilet

• Tub transfer bench

• Walker standard, purchase

• Walker 2-wheel, purchase

Walker 4-wheel, purchase

• Walker bariatric, purchase

• Wheelchair manual, purchase

Items added to the benefit list

Nipple shields will be added as open benefits. No prior approval is required up to a maximum quantity of twelve nipple shields in six months, to a maximum price of $15.00 each.

Electronic blood pressure (BP) monitors (with arm cuff only) will also be added as open benefits. No prior approval is required for up to $100.00 per monitor with a recommended frequency guideline of one per five years.

Bi-level positive airway pressure (BPAP) and auto-continuous positive airway pressure (APAP) systems will no longer be covered on an exception basis. However, prior approval will be required.

Battery powered portable bath lifts will become listed benefits (prior approval required). This includes standard and bariatric bath chair lifts for purchase or rental, as well as batteries and repairs.

Items related to gender affirmation - The NIHB Program has added a number of items as open benefits (with no prior approval required) to support gender identity. Examples of such items include upper body garments (e.g., binders), lower body garments (e.g., gaffs), packers, bra inserts and stand-to-pee (STP) devices.

Important note:

Many items and services are covered under NIHB without prior approval. The program calls them “open benefits” or “schedule A services” (for dental benefits). These benefits often have Program guidelines for the maximum price, number of items or frequency of service that NIHB covers.

Based on your medical needs, the NIHB Program may cover more of these items or services (or, at a higher price) on an exception basis, with prior approval. Your service provider can submit a prior approval or predetermination request for additional coverage. You or your provider can contact the NIHB Program for more information about what information is required at 1-877-483-1575.